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peds > ch 31 the child with endocrine dysfunction > Flashcards

ch 31 the child with endocrine dysfunction Flashcards

1
Q

type of hormone: create the effect near the point of secretion

A

local hormone

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2
Q

type of hormone: released into the bloodstream
where they are carried to responsive tissues

A

general hormone

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3
Q

what 2 regulatory systems maintain homeostasis

A

endocrine system
autonomic nervous system (sympathetic and parasympathetic)

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4
Q

when does hormonal control of bodily functions regulate for children

A

12-18 months old

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5
Q

what hormone is deficient in hypopituitarism

A

growth hormone

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6
Q

how is diagnosis of hypopituitarism made

A

-plasma growth hormone levels
-hand xrays

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7
Q

Tx hypopituitarism

A

-biosynthetic growth hormone injections
-thyroid extract
-cortisone
-testosterone/estrogen/progesterone

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8
Q

what is the best time of day to give biosynthetic growth hormone injection

A

before bed

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9
Q

Rare neurodegenerative
condition reported in some
patients after receiving
human GH from cadavers

A

Creutzfeldt-Jakob Disease (CJD)
“human mad cow disease”

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10
Q

what disorders can hyperpituitarism result in

A

-acromegaly
-cushings disease
-galactorrhea

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11
Q

S+S acromegaly

A

-excess growth hormone, overgrowth of long bones
-increased muscle
-typical facial features

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12
Q

how is diagnosis of acromegaly made

A

-radiologic studies
-endocrine studies

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13
Q

Tx hyperpituitarism

A

-surgery to remove tumor
-radiation/radioactive implants
-hormone replacement therapy

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14
Q

what ages do precocious puberty occur in girls? boys?

A

girls: before 8 yo
boys: before 9 yo

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15
Q

3 types precocious puberty

A

-central
-peripheral
-incomplete

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16
Q

potential causes of precocious puberty

A

-disorder of gonads
-disorder of adrenal glands
-disorder of hypothalmic-pituitary-gonadal axis

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17
Q

med for Tx precocious puberty
when is it discontinued

A

lupron: slows prepubertal rates
stop med at normal puberty age

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18
Q

primary causes of diabetes insipidus (DI) ? secondary causes?

A

primary: hyposecretion of ADH
secondary: trauma, tumor, CNS infection, aneurysm

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19
Q

S+S diabetes insipidus in children? infants?

A

children:
-polyuria
-polydipsia (thirst)
-first sign often enuresis (bedwetting)
-dehydration
-high H&H
-high serum osmolarity

infants:
-irritability relieved by water (not milk)

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20
Q

meds for Tx of DI

A

-daily hormone replacement of vasopressin
-DDAVP (oral/nasal/IM/SQ)

*treatment for life

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21
Q

nursing interventions for DI

A

-accurate I&Os
-observe for signs of fluid overload
-seizure precautions
-DDAVP 2x/day

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22
Q

Produced by
hypersecretion of the
posterior pituitary
(increased ADH)

A

syndrome of inappropriate antidiuretic hormone (SIADH)

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23
Q

S+S SIADH

A

-fluid retention (water intoxication, overhydrated)
-anorexia
-N/V
-weight gain
-hyponatremia
-low serum osmolarity
-irritability
-personality changes

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24
Q

risk with DI

A

hypovolemic shock

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25
Q

risk with SIADH

A

seizures

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26
Q

common S+S between DI and SIADH

A

excessive thirst

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27
Q

Tx SIADH

A

hypertonic saline
fluid restriction

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28
Q

causes juvenile hypothyroidism

A

-congenital
-acquired (after thyroidectomy or radiation)

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29
Q

S+S hypothyroidism

A

-slowed growth
-excessive weight gain
-constipation
-sleepiness
-delayed puberty
-dry skin, sparse hair, periorbital edema

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30
Q

Tx hypothyroidism

A

-thyroid hormone replacement
-prompt Tx needed for brain growth in infant

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31
Q

causes hyperthyroidism

A

-congenital (usually from maternal use antithyroid drugs during pregnancy)
-acquired (neoplasm, inflammatory disease, dietary deficiency, increased secretion thyrotropic hormone)

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32
Q

important consideration for infant born with hyperthyroidism (goiter)

A

-precautions for emergency ventilation
-hyperextension of neck helps with breathing

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33
Q

most common cause thyroid disease in children/teens

A

lymphocytic thyroiditis

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34
Q

S+S lymphocytic thyroiditis

A

-lymphocytic infiltration of thyroid gland
-inflammation
-hyperplasia (goiter)
-usually euthyroid but with S+S of hypothyroidism

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35
Q

Tx lymphocytic thyroiditis

A

-may resolve spontaneously within 1-2 yrs
-oral thyroid hormone helps decrease goiter
-surgery is contraindicated

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36
Q

S+S hyperthyroidism (graves disease)

A

-exopthalmos
-excessive motor irritability, tremors, insomnia, short attentions pan
-GI hyperactivity (diarrhea)
-rapid bounding pulse
-dyspnea (even with light exertion)
-heat intolerance (skin is warm and flushed)

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37
Q

Dx of graves disease

A

-increased T3 and T4
-decreased TSH

38
Q

Tx graves disease

A

-antithyroid drugs (PTU and methimazole)
-subtotal thyroidectomy
-ablation with radioiodine

39
Q

what things can cause thryotoxicosis “thyroid storm”

A

-infection
-surgery
-discontinuation of antithyroid therapy

40
Q

Tx thyrotoxicosis

A

-antithyroid drugs
-propranolol

41
Q

what can you not eat when you take thyroid replacement meds

A

no dairy within 1-2 hrs of taking med

42
Q

how does parathyroid hormone maintain serum calcium

A

-bone breakdown to release calcium and phosphate
-helps kidneys absorb calcium and excrete phosphate
-promote calcium absorption in GI tract

43
Q

2 types hypoparathyroidism

A

-autoimmune hypoparathyroidism
-pseudohypoparathyroidism

44
Q

type of hypoparathyroidism: deficient production of parathyroid hormone

A

autoimmune hypoparathyroidism

45
Q

type of hypoparathyroidism: production of parathyroid hormone is increased but organs are unresponsive to it

A

pseudohypoparathyroidism

46
Q

facial muscle spasm elicited by tapping facial nerve in region of parotid gland

A

chvostek sign

47
Q

carpal spasm elicited by pressure applied to upper arm

A

trousseau sign

48
Q

carpopedal spasm (sharp flexion wrist and ankle joints), muscle twitching, cramps, seizures, stridor

A

tetany

49
Q

earliest indication hypoparathyroidism

A

*anxiety and mental depression
then paresthesia and heightened neuromuscular irritability

50
Q

S+S hypoparathyroidism

A

-dry scaly skin with eruptions
-brittle hair and nails
-tetany
-paresthesia
-tingling
-laryngeal stridor
-headache
-seizures
-depression, confusion, memory loss
-positive chvostek and trousseau signs

51
Q

primary and secondary causes of hyperparathyroidism

A

primary: adenoma of gland (catecholamine secreting tumor)
secondary: chronic renal disease, congenital abnormalities of urinary tract

52
Q

Tx hyperparathyroidism

A

-surgical removal
-or treat underlying cause
-address hypercalcemia

53
Q

three groups of secretions from adrenal cortex

A

-glucocorticoids (cortisol)
-mineralcorticoids (aldosterone)
-sex steroids (androgens, estrogens, progestins)

54
Q

what does the adrenal medulla secrete

A

catecholamines: epinephrine and norepinephrine

55
Q

causes acute adrenocortical insufficiency “adrenal crisis”

A

-hemorrhage into gland after trauma
-sudden severe infections
-abrupt withdrawal supplemental cortisone
-failure to increase cortisone during times of stress

56
Q

what is chronic adrenocortical insufficiency called (not enough cortisol)

A

addisons disease

57
Q

possible causes cushings syndrome (too much cortison)

A

-excessive/prolonged steroid therapy
-excess ACTH production from pituitary
-hypersecretion glucocorticoids from adrenal
-extrapituitary neoplasm
-inappropriate adrenal response to secretion of polypeptide (food dependent)

58
Q

S+S cushings disease

A

-excessive hair growth
-moon face
-weight gain
-truncal obesity with red striae
-poor wound healing
-ecchymosis

59
Q

how is Dx of cushings disease made

A

-blood test: excess cortisol levels
-xray
-fasting blood glucose
-serum electrolytes
-24 hour urine

60
Q

Tx cushings disease

A

-surgery
-replacement of growth hormone, ADH, thyroid hormone, gonadotropins, steroids

61
Q

A family of disorders caused by
decreased enzyme activity
required for cortisol production
in the adrenal cortex; overproduction of adrenal androgens

A

congenital adrenal hyperplasia (CAH)

62
Q

S+S congenital adrenal hyperplasia (CAH)

A

-male: precocious puberty
-female: born with varying degrees of ambiguous genitalia (enlarged clitoris, fused labia, intact internal sex organs)

63
Q

what juices should be given with calcium replacement med to help it be absorbed better

A

cranberry juice
apple juice

64
Q

Dx CAH

A

-ultrasound of pelvic organs
-chromosome typing
-newborn screening measurement of cortisol precursor

65
Q

Tx CAH

A

-assign sex according to gene phenotype
-cortisone to suppress oversecretion ACTH
-reconstructive surgery prn
-teach parents to watch for dehydration and salt-losing crises

66
Q

S+S hyperaldosteronism

A

-HTN
-hypokalemia
-polyuria

67
Q

Tx hyperaldosteronism

A

-replacement potassium
-spironolactone

68
Q

Adrenal tumor that secretes catecholamines

A

pheochromocytoma

69
Q

Tx pheochromocytoma

A

-*do not palpate (releases more catecholamines)
-surgical removal of tumor
-maybe bilateral adrenalectomy, lifelong glucocorticoid and mineralcorticoid replacement

70
Q

3 types diabetes mellitus (DM)

A

-type 1 DM
-type 2 DM
-maturity-onset diabetes of the young (MODY)

71
Q

type of diabetes: Characterized by destruction of beta cells, usually leading to absolute insulin deficiency

A

T1 DM

72
Q

what children are at increased risk for T2DM

A

-native american
-hispanic
-african american

73
Q

cause T2DM

A

insulin resistance

74
Q

type of diabetes: Transmitted as autosomal dominant disorder with formation of structurally abnormal insulin with decreased biologic activity

A

maturity-onset diabetes of the young (MODY)

75
Q

who is more likely to develop MODY

A

-obese teens
-<25 yo

76
Q

Tx MODY

A

-oral hypoglycemic meds
-diet modification

77
Q

Tx T2DM

A

-insulin injections
-diet modification

78
Q

Hyperventilation characteristic of metabolic
acidosis resulting from the respiratory
system’s attempt to eliminate excess CO2 by
increased depth and rate; seen in ketoacidosis

A

kussmaul respirations

79
Q

what can cause diabetic ketoacidosis (DKA)

A

-dehydration
-electrolyte imbalance
-acidosis
-coma

80
Q

S+S ketoacidosis

A

-ketones in urine
-ketones in breath (fruity smell)
-kussmaul respirations (hyperventilation)

81
Q

when would you do urine testing for ketones for T1DM

A

-q3h during illness
-glucose >240 if not sick

82
Q

management T1DM

A

-insulin therapy
-glucose between 80-120
-measurement A1C

83
Q

longterm complications DM

A

-microvascular: nephropathy, retinopathy
-macrovascular: neuropathy

84
Q

nursing consideration when running insulin through IV

A

*run 50-100 mL out for priming
it takes 50-100 mL for tubing to be saturated and not have insulin stick to it

85
Q

what fluids are given for DKA

A

normal saline
(no dextrose)
bolus = 20 mL/kg in <20 mins
IV drip: 0.1 U/kg/hr normal insulin

86
Q

peak + duration regular insulin (rapid acting)

A

30-90 mins
(duration 5 hrs)

87
Q

peak + duration short acting insulin

A

peak 2-4 hrs
duration 4-8 hrs

88
Q

peak + duration intermediate acting insulin

A

peak 4-14 hr
duration 20 hrs

89
Q

peak + duration long acting insulin (lantus)

A

no peak
lasts 24 hrs

90
Q

how do you draw up multiple types of insulin in one syringe

A

clear to cloudy

peds (28 decks)

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